Thursday, June 29, 2006
Well boy was I set back on the right path - what was I thinking by trying to impose my snooty value judgements on these fine parents? I was given a right royal serving and told to go elsewhere. I was chastened yes, but still I hadn't quite learned my lesson and figured I let the Police deal with it.... 'cause although I had a uniform and some flashing lights and stuff, I was apparently a "wanna-be cop who can't mind his own business". Despite an afternoon phone call to the police, I was outsmarted once again because the vehicle was not even registered.
Sunday, June 25, 2006
Recently we got dispatched to do a routine code 3 transport. We get to do these when the private company that has the contract to handle these jobs is too busy or is “unable to meet the timeframe” – this seems to happen quite a lot. Normally this means the patient needs to get to dialysis or some other appointment and does not need an emergency ambulance. This particular patient was scheduled by her doctor to go and have a CT scan due to a week of severe headaches. We are usually required to be there within an hour of dispatch – this means you can at least finish your cuppa at branch and don’t exactly need to run to the truck :)
On arrival my partner and I were met at the door by the patient’s husband (who only spoke a little English) who led us to the lounge room where we walked in to find a young woman sitting on a couch, wearing a nightie and being supported by some other family members. I introduced myself and got no response from the woman; she didn’t meet my gaze and just stared off into the distance vacantly. I asked her husband what had been happening today - I already knew we had been called to take her down to her appointment but I wanted to find out a little more. After a long and unproductive attempt at conversation involving several elderly family members I finally resorted to conversing only with the primary school age child who was there. She was able to give me really good yes and no answers – kids are great like that.
It turns out that this woman had indeed had a history of headaches and vomiting for about a week and her doctor had decided it was time to do a scan to try and rule out anything sinister like a tumour or a bleed of some kind. She’d had a baby about 4 months ago and had been in good health since. However she’d been completely non-conversant since getting out of bed in the morning and had been found standing in the kitchen “with her eyes going all crazy” or just sitting on the couch staring like she was now. My partner and I both looked at each other realising that this woman was possibly quite unwell and we would be taking her to an emergency department and not to her appointment. I tried to assess her but she would get really irritated and resistive, letting out some horrible guttural screams whenever she was touched by anybody. I was beginning to think she had possibly had a cerebral event of some sort – that might fit with the recent history of headaches. She appeared to have full use of her arms and legs when pushing me away and there was no obvious facial droop – so the classic stroke symptoms weren’t there. That of course did not rule out anything. As we loaded her into the ambulance I’m watching her carefully trying to observe anything that might give me a clue as to what was happening; stroke? drug use? psychosis?... no sign of trauma… hmm... fake symptoms? hypoxia? metabolic cause? Was she hypoglycaemic?….nope. What was going on here?
With a lot of effort I managed to get a baseline set of vital signs an oxygen mask on her for a total of about 3 seconds, then she rolled onto her stomach on the stretcher and despite repeatedly turning her back over she kept screaming out when touched. She had adequate blood pressure and pulse and was breathing well. Eventually I figured I’d leave her alone and just hold the oxygen mask right near her face – I was sure if she was having a cerebral event then the effort of fighting our attempts to assess her would be doing her intracranial pressure no good at all. Hospital was nearby so it was fortunately a short trip. When we arrived I got that look from the triage nurse as which said; why are you bringing in an altered conscious state patient lying on their stomach? I explained how combative she had been and as the staff tried to help us move her off the stretcher it soon became evident to them too. I left them with a diagnosis of “Sorry, I just dunno” – I guess that’s why we brought her to hospital.
Late in the shift when we went back to the same hospital we checked back to see how she was doing – I was surprised to see she’d been sedated and intubated. They’d done a scan of her head and found nothing, checked her blood and spinal fluid and again found nothing. The doctors were talking about possible postpartum psychosis, but they too were scratching their heads. I came back the next day and again asked if they had found anything. But they had transferred her to another hospital when they found after extubating her she was worse, even more irritated and combative. I really hope she was ok.
Saturday, June 17, 2006
We jumped in the truck and headed out to the staging area where we were meeting the other emergency services, thinking we would find a single fire truck and some old guy from the airport telling us where to park. We pulled off the freeway and there was an absolute sea of flashing lights, police cars, fire trucks, airport vehicles, ambulances, managers, about a hundred people all milling around wearing reflective yellow vests. Not wanting to be left out, my partner and I donned (I love that word) our high visibility gear and went to find the commander in charge.
We were told to follow a couple of fire trucks out onto the tarmac area to standby. The plane was going to do a fly-by of the tower to see if the landing gear was down. Fortunately it was, but the lights in the cockpit said otherwise so we were all poised, ready to clean up the results. After circling for a while to dump fuel, finally the plane appeared again and there was a brief tense moment as it touched down when we all waited to see if the landing gear would hold. I'm happy to say it was a textbook landing and the plane rolled to a stop without incident. So I'm slightly bummed I didn't get to see them bury the plane in fire retardant foam, but I'm glad everyone was ok.
We took off our vests and cleared from the job after having a quick chat to some of the other crews there. Almost immediately the MDT let out that sound and we were dispatched to an Unknown Problem - Third party caller. That pretty much says it all. Armed with just slightly more than no information we headed back out into the afternoon.
Friday, June 16, 2006
On the night shifts it just doesn't stop. Back to branch to re-stock and then out again for more. Its strange when you then talk to some of the other cars who are only a suburb or two away and get told they have not turned a wheel after midnight. I know the dispatchers are trying to maintain coverage, but surely they could drag a couple of the quieter peripheral cars out of bed and get them to take just a few of the jobs, You know, maybe share the love a little?
The upside of this (there is always an upside) is that I've been getting home so tired that I have been sleeping really well after night shifts. Despite being loaded with caffeine I'm managing to sleep all the way through til mid afternoon when my alarm goes off. Although all the stuff I usually get up and do between nightshifts is getting neglected. My neighbour just asked me if I'd like to borrow his lawn mower - do you think he's trying to tell me something?
Thursday, June 15, 2006
Sunday, June 11, 2006
About 10 years ago I got my first mobile phone. It was a great big clunky thing that ran on a now defunct network. Reception was pretty ordinary but it soon wangled its way into my life, quickly becoming an “essential” part of my every day. I soon developed a kind of pre-flight check as I left the house each day that comprised of patting various pockets and saying out loud “wallet….keys… phone”. Now if I forget my phone somewhere I get the same feeling I used to get if I misplaced my wallet; a brief flash of fear followed by the creeping realisation that if I don’t have my phone, then I’m screwed, how will I get all my numbers back?, no one will be able to reach me!
I vaguely remember my life before I grew that digital appendage, before I became slave to the mobile millstone, but what I can’t picture now is how I actually managed to function without it. Australia has one of the highest uptakes of mobile phones in the world. We can’t get enough of them. Just about everyone has one and it is rare that you meet someone who doesn’t. In ambulance this has changed things - a lot. On the plus side mobile phones have given many people access to emergency services a lot quicker than may have been the case in the past.
Now however, all 25 bystanders at an event will now call the ambulance rather than one person heading down to the nearest phone box, so there may be multiple calls to one event. People driving past an accident (or even past someone asleep in their car) will now call an ambulance without actually stopping to see if one is needed. As a result they can’t give the calltaker any details because they are now 10k away down the freeway.
The biggest change that I see in my little pre-hospital window of time is that carloads of concerned relatives will now get to the scene before the ambulance does and then continue turning up while you are there, often blocking the street with their cars making egress impossible. Just when you have calmed down an already elevated and hysterical scene another car will pull up and it’s all on again. I now often find myself deeply concerned with the wellbeing of the convoy of hysterical relatives following the ambulance to hospital – on more than one occasion now I’ve had to pull over the ambulance and walk back to tell the procession to settle down before they cause another accident.
Mobile phone use is insidious and pervasive. I say this because a few days ago for the first time, I used a mobile phone as an assessment tool, I even used it in my handover to the triage nurse at hospital and she didn’t bat an eyelid. My patient was pretending to be unconscious. She had called her case worker and told him she had taken an overdose, he had done the right thing by his client and called an ambulance to attend and make sure she was ok. She was able to walk and talk just fine at the scene but suddenly in the back of the ambulance she was only able to be roused with a lot of a shoulder shaking and a loud voice… until her mobile phone rang. At which point I think she forgot to be unconscious and answered it – asking whoever it was on the other end to “bring me in some smokes will ya”. Then she ended the call and became “unconscious” again. This occurred a total of three times en route.
On arrival at hospital she was still “unconscious” and triage looked at me quizzically until I explained the mobile phone usage. As I went off to do my paperwork I saw the triage nurse heading into the cubical with a sly grin to protect the “unconscious” patients’ airway with a large nasopharyngeal airway. Let’s just say she was not unconscious for long. I headed back out to the car and the first thing I did was check my messages.
Saturday, June 03, 2006
We got into the heart of the city and saw humanity at its finest as drunken mates brawled with strangers and each other. We did however see a kid having a seizure (it was his first one, so he got to go to hospital for investigation) and had a few patients who actually needed an ambulance.
About a third of my patients last night were in police custody for various reasons. Some had been fighting and had lost, some were PFO's (pissed and fell over), some had been arrested for drink driving and now thought that a theatrical "I'll just throw myself to the floor and pretend I'm unconscious" was going to make the police charges go away. Wrong.
Its hard to pick my favourite job from the last 24 hours...but here are some "honorable Mentions":
The young man who had just taken a big syringe full of amphetamines and was now feeling "jittery" and restless. Newsflash - that's what happens when you pump low-grade poison into your veins. He kept grabbing at me and saying; "You gotta help me - I'm dying". He wasn't and he didn't.
The bloke on the street corner who insisted on being taken right across town to a particular hospital because he had a really bad pain in his shoulder, oh and yeah, it was near his house - who then walked straight out of the ambulance, through the waiting room and went home. Ever heard of using a taxi?
The girl who was so drunk, she was lying in her own vomit and urine on the footpath and whose friends thought that they'd leave her there to sleep it off while they stayed in the pub to keep drinking. I wish I had friends like that.
A particular winner for me was the group of 16 year olds apprehended by the police with a shopping trolley full of household letterboxes they had been stealing - what the hell were they intending to do with them?